Carers Registration Form

A generally accepted definition of a carer is: anybody who is looking after a relative, partner or friend who, because of illness, old age or disability, may not be able to manage at home without them.

Employees of Social Work are not classed as “family” carers for the purpose of this exercise, although there could be some circumstances where an employee could fit into both categories, depending on their personal situation.

CONFIDENTIAL

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Your Details
Name
Date of Birth
Address
Postcode
Tel. no.
Email
GP Practice you are Registered with
Details of the Person You Care For
Relationship to you
His / Her name
Date of Birth
Their GP if different from your own
GP Practice
Reason for Caring
It could be beneficial if the other Doctor or Practice was aware of your caring role. Would you be willing to allow us to pass this information on?
- Yes
- No
Would you like us to arrange for a Carer Support Plan for you, which will enable us to find out if we can help you in your caring role eg. Respite, training, support, financial help etc?
- Yes
- No
If yes, we will contact you to arrange this.
Would you be willing to allow us to share basic information with Social Work or the Health Board?
- Yes
- No
Phone
This field is for validation purposes and should be left unchanged.

Carer's Signature ________________________________________ Date ________________________________________ Return to: Room 14, Council Offices, Tarbert, Isle of Harris HS3 3BG

Carers Registration Form

CONFIDENTIAL

Your Details

Details of the Person You Care For

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